Influence of the COVID-19 Pandemic on Treatment Times for Acute Ischemic Stroke: The Society of Vascular and Interventional Neurology Multicenter Collaboration.

Autor:	Siegler JE; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.)., Zha AM; Department of Neurology, University of Texas Health Science Center at Houston, TX (A.M.Z., A.L.C.)., Czap AL; Department of Neurology, University of Texas Health Science Center at Houston, TX (A.M.Z., A.L.C.)., Ortega-Gutierrez S; Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics (S.O.-G., M.F.)., Farooqui M; Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics (S.O.-G., M.F.)., Liebeskind DS; Department of Neurology, Ronald Reagan University of California at Los Angeles (D.S.L.)., Desai SM; Department of Neurology, University of Pittsburgh Medical Center Mercy Hospital, PA (S.M.D., A.P.J.).; Department of Neurology, University of Pittsburgh Medical Center Presbyterian Medical Center, PA (S.M.D., A.P.J.)., Hassan AE; Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center, Harlingen, TX (A.E.H.)., Starosciak AK; Center for Research (A.K.S.), Baptist Health South Florida, Coral Gables., Linfante I; Department of Interventional Neuroradiology and Endovascular Neurosurgery (I.L.), Baptist Health South Florida, Coral Gables., Rai V; OhioHealth Neuroscience Center, Riverside Methodist Hospital, Columbus (V.R.)., Thon JM; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.)., Then R; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.)., Heslin ME; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.)., Thau L; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.)., Khandelwal P; Department of Endovascular Neurological Surgery and Neurology, Robert Wood Johnson University Hospital, New Brunswick, NJ (P.K.)., Mohammaden MH; Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (M.H.M., D.C.H., R.G.N.)., Haussen DC; Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (M.H.M., D.C.H., R.G.N.)., Nogueira RG; Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (M.H.M., D.C.H., R.G.N.)., Jillella DV; Department of Neurology, Emory University Hospital, Atlanta, GA (D.V.J., F.N.)., Nahab F; Department of Neurology, Emory University Hospital, Atlanta, GA (D.V.J., F.N.)., Kaliaev A; Department of Interventional Neurology and Neuroradiology, Boston Medical Center, MA (A.K., T.N.N.)., Nguyen TN; Department of Interventional Neurology and Neuroradiology, Boston Medical Center, MA (A.K., T.N.N.)., Zaidat O; Department of Neurology, Mercy Health St. Vincent Hospital, Toledo, OH (O.Z.)., Jovin TG; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., J.M.T., R.T., M.E.H., L.T., T.G.J.)., Jhadav AP; Department of Neurology, University of Pittsburgh Medical Center Mercy Hospital, PA (S.M.D., A.P.J.).; Department of Neurology, University of Pittsburgh Medical Center Presbyterian Medical Center, PA (S.M.D., A.P.J.).
Jazyk:	angličtina
Zdroj:	Stroke [Stroke] 2021 Jan; Vol. 52 (1), pp. 40-47. Date of Electronic Publication: 2020 Nov 30.
DOI:	10.1161/STROKEAHA.120.032789
Abstrakt:	Background and Purpose: The pandemic caused by the novel coronavirus disease 2019 (COVID-19) has led to an unprecedented paradigm shift in medical care. We sought to evaluate whether the COVID-19 pandemic may have contributed to delays in acute stroke management at comprehensive stroke centers. Methods: Pooled clinical data of consecutive adult stroke patients from 14 US comprehensive stroke centers (January 1, 2019, to July 31, 2020) were queried. The rate of thrombolysis for nontransferred patients within the Target: Stroke goal of 60 minutes was compared between patients admitted from March 1, 2019, and July 31, 2019 (pre-COVID-19), and March 1, 2020, to July 31, 2020 (COVID-19). The time from arrival to imaging and treatment with thrombolysis or thrombectomy, as continuous variables, were also assessed. Results: Of the 2955 patients who met inclusion criteria, 1491 were admitted during the pre-COVID-19 period and 1464 were admitted during COVID-19, 15% of whom underwent intravenous thrombolysis. Patients treated during COVID-19 were at lower odds of receiving thrombolysis within 60 minutes of arrival (odds ratio, 0.61 [95% CI, 0.38-0.98]; P =0.04), with a median delay in door-to-needle time of 4 minutes ( P =0.03). The lower odds of achieving treatment in the Target: Stroke goal persisted after adjustment for all variables associated with earlier treatment (adjusted odds ratio, 0.55 [95% CI, 0.35-0.85]; P <0.01). The delay in thrombolysis appeared driven by the longer delay from imaging to bolus (median, 29 [interquartile range, 18-41] versus 22 [interquartile range, 13-37] minutes; P =0.02). There was no significant delay in door-to-groin puncture for patients who underwent thrombectomy (median, 83 [interquartile range, 63-133] versus 90 [interquartile range, 73-129] minutes; P =0.30). Delays in thrombolysis were observed in the months of June and July. Conclusions: Evaluation for acute ischemic stroke during the COVID-19 period was associated with a small but significant delay in intravenous thrombolysis but no significant delay in thrombectomy time metrics. Taking steps to reduce delays from imaging to bolus time has the potential to attenuate this collateral effect of the pandemic.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu